Haemolytic disease of the newborn

Question 1

What is heamolytic disease of the newborn?

Answer 1

Maternal AB against the foetal blood groupe antigen -classicaly anti D, A/B, Rell
mother is always Rh- (has Ab against) and kid Rh +
always needs a first contact - first child with +ve, immune transfusion, etc -so that AB are present (for first child, blood is in contact during birth)
-> AB cross palcenta (unlike Ag) and cause heamolysis

Sx -
Yellow amniotic fluids 
Hydrops fetalis -abnormal fluid in baby cavities  (usually cardiosplenomegaly)
Pallor
Jaundice 24-36h after birth

Question 2

Ix and Mx of heamolytic disease of the new borrn

Answer 2

Ix - coombs test (DAT) -positive
heamlyiss -raised uBR and reticulocites
amnioscientesis (sample fluid) -detect AB
USS

Mx -
prevention– can give prophylaxis after sensitising events if at risk -
Kleinheur test detetmines levels-
200IU before 20 or 500IU after 20
Routine antenatal antiD prophylaxis - 2 doses during pregnancy

Tx - Phototherapy to get rid of uBR and IVIG (if bili over 8.5ug/L
Severe or in utero -transfuse O- rh- blood in umbilical vein + delivery at 37w